woostermd

Vascular surgeon. MD, MBA, RPVI, FSVS, FACS. Conflicted passion for complex aortic and CLI while refusing to sacrifice #comprehensivevascularcare. Salt life.

[Mladen Vidovich @mividovich]

1/
Every interventional cardiologist has been trained that radiation dose is their responsibility: fluoro time, frame rates, collimation. Nobody asks how old the machine is. We asked. Median age: 17 years. 🧵

[woostermd @woostermd]

@Toursavadkohi @dr_ghoreishi @UMMC Congrats buddy. Love seeing this—acute type a likely the best case for this while ironically the one most likely to be shied away from.

[woostermd @woostermd]

@farkomd <60%pp at 1 year in fem-pop segment, presumably short interposition bypasses = durable? Reviewer number 2 may have been clicking buttons to get through his/her workload.

[woostermd @woostermd]

I dream of a day that a patient can look up the cost of their healthcare prior to even booking a visit. Not a 12 phone call insurance “estimate of benefits”. An actual price.

[woostermd @woostermd]

@CaitlinWHicks @JAMASurgery @Chen__Dun @Terrence_Tsou @andrewyhwu @corey_kalbaugh @JHHVascular @HopkinsMedNews @hopkinssurgery @JHUWelchCenter @MidoriWhite @VascularSVS Interesting that typically higher reimbursing “private” have higher use of SET. More likely to offer SET in higher socioeconomic region? More likely to reimburse it? Or is this a solitary example of positive impact of prior authorization?

[Medical University of South Carolina (MUSC) @MedUnivSC]

A new device at @MUSChealth allows doctors to treat aortic aneurysms without surgery, providing safer options for patients like Arthur Kemp. Developed by Dr. Mathew Wooster, this invention reduces stroke risks and improves patient outcomes.

Learn more: https://t.co/bmLmbhG0S4

[woostermd @woostermd]

@XDPham @canuc_57 @farkomd @AortophilicMD @DonaldBaril @jmills1955 @thesurgerylife @vascularIR @IRKhalsa @AnahitaDua @limbsalvagedr @docpark @marlobat @HadyLichaaMD @monteromiguel @YsaAugust Accurate. We are all ignoring that the hypo collaterals make it to the profunda almost before the profunda fills suggesting residual disease. 6mm pretty small for CFA intervention….endo has a role for CFA. Data continues to show it as subpar results to open though.

[woostermd @woostermd]

The future is here. #aortaed thrilled to be able to offer advanced endovascular solutions to patients without other options. #endobentall made feasible thanks to collaborative care with @DrZeigler1 @MUSCVascular @MUSCSurgery @MUSCCardFellows

**patent RIMA-RCA bypass not shown**

[woostermd @woostermd]

#aortaed. Early branches pose challenges for maintaining adequate endovascular seal. Here we demonstrate one technique for ensuring seal without having to embolize large branches by utilizing the BeBack catheter to perforate a VBX stent. **off label**

[woostermd @woostermd]

@smbracewell @DrJayMohan @jcgeorgemd @EricSecemskyMD @JimGMelton @JunLiMD @HadyLichaaMD @LuaySayed @drochohan @ShariqShamimMD @IRKhalsa @kmadass Can use astato, I’ve also use confianza and v18 wire. I personally haven’t used it for this indication, have used it for in situ fenestration and septotomies, same concept though.

[woostermd @woostermd]

@DrJayMohan @jcgeorgemd @EricSecemskyMD @JimGMelton @JunLiMD @HadyLichaaMD @LuaySayed @drochohan @ShariqShamimMD @IRKhalsa @kmadass Ultimately though, would consider fixing inflow only—iliac to profounda—atherectomy, dcb, etc as needed and it’s likely to be sufficient—any idea why he “failed” endart twice? Incomplete endart? Rapid neointimal response to unwashed bovine patch? Dissection/clamp injury?

[woostermd @woostermd]

@DrJayMohan @jcgeorgemd @EricSecemskyMD @JimGMelton @JunLiMD @HadyLichaaMD @LuaySayed @drochohan @ShariqShamimMD @IRKhalsa @kmadass Right at the edge, infuriating! Stiffer support from below—long 4fr sheath all the way to where you’ve progressed “should” give the needed support, or go to 5fr so you add an oversized balloon inflated as highest level of support. Electrified 0.014/8 wire next option.

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Since the introduction of electronic health records (EHRs), US healthcare has seen zero productivity gains, while nearly every other sector has improved output per worker. Healthcare remains stagnant.

Imagine a restaurant implementing software for seating, orders, and billing that cut efficiency by 50%. Picture a chef spending as much time on the computer as cooking, or waiters filling out meaningless checkboxes as often as they take orders. That software would be discarded immediately.

Would any industry accept "innovations" that slash productivity?

These inefficient systems were forced on physicians by corporate conglomerates, not to optimize patient care, but to maximize billing. They’re designed to capture every CPT code, comorbidity, and game the "observed-to-expected" metrics, all at the cost of physician and nurse efficiency.

As a result, success in medicine is no longer about diagnostic skill, empathy, or surgical expertise—it’s about surviving the endless clicks required each day.

What if "clicks per encounter" or "EHR time outside work hours" were CMS quality metrics, weighted like readmissions or patient satisfaction scores?

To reverse the burnout crisis, we must demand that health systems improve EHR efficiency. Repeal meaningful use and inject competition into the EHR market.

Improving the EHR will make doctors more efficient, decrease healthcare spending and improve outcomes.

Lets make medicine less about clicking and more about healing.

@anish_koka @EconTalker @MarilynHeineMD @LeahHoustonMD @ReasObBob @TomRomeo5 @cscla

[Adam Bruggeman, MD @DrBruggeman]

Going to say it again…

1998 conversion factor for doctors - $36.68

2024 conversation factor for doctors - $33.29

1999 Insurance premiums - $6k

2024 Insurance premiums - $24k

When you pay more for healthcare, it’s not coming from private, independent doctors no matter what the insurers, politicians, or news stories say. Physicians are paid less in absolute terms over the last 25 years while insurers are up 314% and inflation is up 83%

We need a long term solution to ensure physicians are paid commensurate with their cost of doing business. Our country is on an unsustainable path in healthcare where all of the profits are going to insurers and hospitals, leaving physicians no choice but to vertically integrate, which drives costs even higher.

[woostermd @woostermd]

@SDhandMD Nicely done, preserving those circumflex vessels so valuable for avoiding acute critical limb in the future! I prefer safety of viabahn here when there is a healthy nub proximal to circs, if not then PTX—with covered stent on standby especially in 87 year old arteries!

[woostermd @woostermd]

@SDhandMD @LessneVIR @farkomd @AmputationSuck @jmills1955 @canuc_57 @paragpatel_IR @DonGarbettMD @kmadass @NorthwesternIR Nice case. We use the 400 stiff angle glide, the jaguar, or the metro wire. Depends on what has been re-ordered and is off back order!

[woostermd @woostermd]

Excited to announce on behalf of @MUSCVascular @AdamTanious @DrZeigler1 and myself, our design for modular, transfemoral, off the shelf aortic arch repair is official US PATENT APPROVED! Hopeful to present our early series at a conference later this year #collaboration #aortaed

[woostermd @woostermd]

Sometimes you have to move a couple of branches out of the way… #aortaed @DrZeigler1 @MUSCVascular

[woostermd @woostermd]

Anyone found a CPT code to bill insurance companies for time spent on hold/on phone for peer to peer requests? Asking for a friend who definitely hasn’t been on hold for 30 minutes with @Humana who has taken over three weeks and counting to approve a procedure…

[woostermd @woostermd]

Each aorta is unique. Tailoring care to individual patients by working with colleagues leads to best outcomes #withandwithoutaknife @DrZeigler1